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Review
. 2023 Apr 17;12(5):e220513.
doi: 10.1530/EC-22-0513. Print 2023 May 1.

Diagnostic criteria and proposed management of immune-related endocrinopathies following immune checkpoint inhibitor therapy for cancer

Ruth Percik  1 , Sherwin Criseno  2 , Safwaan Adam  3 , Kate Young  4 , Daniel L Morganstein  5   4
Affiliations
Review

Diagnostic criteria and proposed management of immune-related endocrinopathies following immune checkpoint inhibitor therapy for cancer

Ruth Percik et al. Endocr Connect. .

Abstract

Checkpoint inhibitors are now widely used in the management of many cancers. Endocrine toxicity is amongst the most common side effects. These endocrinopathies differ from most other immune-related toxicities in frequently being irreversible and rarely requiring cessation of checkpoint inhibitor therapy. This review considers an approach to the presentation and diagnosis of endocrinopathies, compared to classical endocrine diagnosis, suggesting improvements to classification and treatment based on fundamental endocrine principles. These will help to align management with other similar endocrine conditions and standardise the diagnosis and reporting of endocrine toxicity of checkpoint inhibitors to improve both endocrine and oncological care. In particular, the importance of considering any inflammatory phase (such as painful thyroiditis or hypophysitis resulting in the pituitary enlargement), from the endocrine consequences (transient hyperthyroidism followed by hypothyroidism, pan-hypopituitarism or isolated adrenocorticotrophic hormone deficiency), is highlighted. It is also important to consider the potential confounder of exogenous corticosteroids in adrenal suppression.

Keywords: cancer; checkpoint inhibitor; endocrinopathy; hypopituitarism; immunotherapy; thyroid.

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Conflict of interest statement

DM reports personal fees from Bristol Meyer Squibb, personal fees from MSD, personal fees from Roche. SC reports personal fees from Bristol Myer Squibb. RP, SA and KY report no declarations.

Figures

Figure 1
Figure 1
Algorithm for assessment of management of hypophysitis following ICPI.
Figure 2
Figure 2
Algorithm for assessment and management of adrenal insufficiency following ICPI.
See this image and copyright information in PMC

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